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What is oppositional defiant disorder?

A type of behavioral disorder, oppositional defiant disorder (ODD), is diagnosed mainly in childhood. While it’s normal for all children to occasionally be rude or hard to care for, children who exhibit symptoms of ODD regularly take a defiant, irritated, and hostile attitude toward their parents, peers, and other figures in their lives. A child with oppositional defiant disorder is generally uncooperative and can be a handful for parents, guardians, and other caretakers to attend to.

Causes

What causes oppositional defiant disorder?

While researchers are unsure of the exact causes lying behind ODD, there are a couple of theories. The main two theories are:

Developmental theory: This theory holds that dependency issues in early childhood are the cause of ODD. If the developmental theory is correct, it would mean that the individual is stuck in a developmental pattern that should have been resolved long ago.
Learning theory: Another theory claims that the symptoms of oppositional defiant disorder are, in fact, learned by the child early in life. By mimicking the negative reinforcement methods of their parents or other authority figures, the child garners attention or reaction from those in charge.

What are the risk factors of oppositional defiant disorder?

Your child may have an increased chance of developing oppositional defiant disorder if they fit in any of the following categories:

They are a male. ODD is more commonly found in boys than in girls.
They have other mental health problems, such as anxiety or mood disorders. Examples of other common conditions include attention-deficit/hyperactivity disorder (ADHD) or conduct disorder.
They have parent or family problems. If they’ve experienced abuse or neglect or inconsistent discipline from authority figures, they may be more likely to develop oppositional defiant disorder.
They have a sensitive temperament. Those with a predisposition to emotionally overreact or who have difficulty managing their emotions have tendencies toward developing ODD.

Can oppositional defiant disorder be prevented?

Although the exact cause of ODD is yet to be discovered, there are certain steps you can take to ensure your child is developmentally well-adjusted. Early intervention programs and behavioral therapy can be effective for young children. For older children and adolescents, psychotherapy and adequate support systems can go a long way. As a parent, you can learn how to manage your child’s behavior more appropriately. Learning proper discipline and how to use positive reinforcement can help your child grow up more well-adjusted and psychologically sound.

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Symptoms

What are the symptoms of oppositional defiant disorder?

It can sometimes be difficult to tell the difference between a hard-headed child and one with oppositional defiant disorder. This discernment is made especially difficult because of the varying levels of severity a child may experience with their ODD. Oppositional behavior is a normal part of a child’s developmental processes, so it’s to be expected from time to time. However, when a child has ODD, these behaviors are disruptive to everyday life. The most widely recognized of these symptoms include:

A hot temper.
Frequent outbursts and temper tantrums
Touchy and easily irritated.
Frequently resentful.
Can be spiteful toward others.
Blames others for their problems.
Refusing to obey authority figures.
Constant arguing.
Deliberately upsets people.

When does oppositional defiant disorder develop?

Most commonly, oppositional defiant disorder develops around preschool. Some individuals begin to show symptoms later than normal but never before entering the teen years. A late diagnosis does not correlate to a late onset of ODD but rather a missed opportunity for diagnosis earlier in life.

Can oppositional defiant disorder be diagnosed in adults?

Yes, oppositional defiant disorder can be diagnosed in adults. In most cases, these are adults who have had ODD their whole lives and have simply gone undiagnosed. In adults, oppositional defiant disorder can manifest in work conflicts, relationship troubles, and a variety of other circumstances. Some other ways ODD shows in adults include:

Feelings of anger directed at the world.
Dislike for authority.
Defensive of themselves.
Blaming others.
Feeling misunderstood.

Diagnosis

How is oppositional defiant disorder diagnosed?

In order to diagnose your child with ODD, your medical professional will first conduct a full psychological evaluation. This assessment will allow them to glean a better understanding of what other conditions may be at play. Your medical professional may ask a variety of questions related to the frequency and range of symptoms, parenting strategies, and more. Diagnosis requires your child to exhibit behavioral and emotional symptoms lasting longer than 6 months. After distinguishing oppositional defiant disorder from other issues, the doctor will be able to diagnose your child with ODD.

Treatment

Can oppositional defiant disorder be treated?

As soon as a diagnosis occurs, it’s imperative to seek treatment for your child’s ODD. Early intervention can make a world of difference in improving your child’s symptoms. Treatment generally takes several months or longer, owing to the need to restructure your and your child’s habits and communication problems. During the treatment process, it’s important to simultaneously address any other mental health conditions your child may have. Co-occurring conditions have the potential to worsen symptoms or disrupt treatment, so it’s key that they are also addressed during treatment.

What treatment options are there for oppositional defiant disorder?

The type of treatment you decide to pursue will depend on a variety of factors, such as the severity of the case, the symptoms presented, and the individual’s health. You may need to try several treatment methods before you find one that works for your child. Some of the most common forms of treatment for children with oppositional defiant disorder are:

Cognitive-behavioral therapy: This form of psychotherapy teaches people how to restructure their negative thought patterns. For children with ODD, it can help them learn how to better communicate and problem-solve with those around them. Cognitive-behavioral therapy can also assist them in controlling angry impulses.
Family therapy: When a child’s ODD affects home life, it can be difficult on the whole family. By attending family therapy, parents and siblings of these children can learn how to communicate healthily as a family. Family therapy also provides the opportunity for family members to learn more about the condition, which translates to a more understanding support system. Alternatively, as a parent, you may decide to partake in individual counseling sessions to learn how to better interact with your child.
Social skills training: If your child is frequently hostile toward peers, social skills training can help shift that behavior. By learning about flexibility and generosity around others, ODD symptoms may improve.
Medication: While there are no medications approved specifically for use with ODD, your child may still benefit from pharmaceuticals. Because many children with oppositional defiant disorder have other mental health conditions as well, medication can help calm the symptoms of other conditions, thereby improving the overall health and well-being of your child.

References

Gotter, A. (2018, June 26). What Is Oppositional Defiant Disorder (ODD)? Healthline. https://www.healthline.com/health/oppositional-defiant-disorder#symptoms

Mayo Foundation for Medical Education and Research. (2018, January 25). Oppositional defiant disorder (ODD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/diagnosis-treatment/drc-20375837

Oppositional Defiant Disorder (ODD) in Children. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/oppositional-defiant-disorder

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Roy Kedem started his premedical studies at Harvard, and research in genetics and gene sequencing at Harvard, Beth Israel. He attended medical school in the UK at the Cambridge Overseas Medical Program in 1998. Dr Kedem then completed his residency in Internal Medicine at Columbia College of Physicians and Surgeons in Stamford, Connecticut and his fellowship in Hospital Medicine at the Cleveland Clinic in Cleveland, Ohio.

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